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Guides you through the decision to have catheter ablation for the heart rhythm problem atrial fibrillation. Lists benefits and risks of catheter ablation and medical therapy. Includes interactive tool to help you make your decision.

Guides you through the decision to have catheter ablation for the heart rhythm problem atrial fibrillation. Lists benefits and risks of catheter ablation and medical therapy. Includes interactive tool to help you make your decision.

Atrial Fibrillation: Should I Have Catheter Ablation?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Normally, the heart
has a strong, steady beat. That beat is controlled by the heart's electrical
system. Sometimes that system misfires, causing atrial fibrillation.

Catheter ablation is a way to treat atrial fibrillation. Your doctor can get into your
heart—without surgery—and fix the misfiring. It's like working on the spark
plugs in your car without having to open the hood.

It's done in a hospital. You'll get medicines to make you sleepy and comfortable during the procedure.

The
doctor inserts thin, flexible wires called catheters into a vein, usually
in the groin or neck. Then the doctor threads the catheters up into your heart.

X-rays and other images of the heart help the doctor
see where to move the catheters.

The catheters use very hot or
very cold temperatures to destroy the areas in your heart that are causing the
misfiring problem.

It may seem like a bad idea to destroy parts of your
heart on purpose. But the areas that are destroyed are very tiny and
don't affect your heart's ability to do its job.

If you have tried heart rhythm medicines already. Your symptoms may not have gone away or you had side effects that are hard to live with.

The choice to have catheter ablation also depends on what you want.

Catheter ablation does
have some serious risks, but they are rare.
Many people decide to have ablation because they
hope to feel much better afterward. That hope is worth the risks to them.
But the risks may not be worth it for people who have few symptoms or for people
who are less likely to be helped by ablation.

Taking anticoagulants (blood thinners)

Many
people think that having ablation means they'll be able to stop taking an anticoagulant (also called a blood thinner), such as warfarin, every day to prevent
stroke. But that is only true if your risk of stroke
is low. Studies haven't proved that ablation for atrial fibrillation lowers your
risk of stroke. So you'll still need to take an anticoagulant if your risk of stroke
remains high. Your doctor can tell you about your stroke risk.

Catheter ablation can stop atrial fibrillation from happening and can relieve symptoms. Your doctor can help you decide if ablation is a good choice based on your health.

Catheter ablation works better in people who have paroxysmal atrial fibrillation (episodes last 7 days or less) than in people who have persistent atrial fibrillation (episodes last more than 7 days). For both types, episodes may go away on their own or go away after treatment. Ablation might be less likely to work the longer a person has persistent atrial fibrillation.2

Ablation works best for younger people who have paroxysmal atrial fibrillation and little or no structural heart disease.

Things that limit how well catheter ablation works include older age, other heart problems, obesity, and sleep apnea.2

Catheter ablation is still
being studied to see how well it works and how safe it is in the long
term.

Paroxysmal atrial fibrillation

Research shows that ablation
helps more than 70 to 80 out of 100 people.3
That means it does not help in about 20 to 30 out
of 100 cases.

Your doctor can help you decide whether the possible benefits of
ablation outweigh these risks.

Problems during the procedure

If problems happen during the procedure, your doctor is prepared to fix them right away. In studies and a worldwide survey, serious problems happened in about 4 out 100 people.6, 4 These problems include an accidental hole in the heart, the need for emergency surgery, and nerve damage in the chest.

Rare problems include cardiac tamponade and stroke. They happen in about 1 out of 100 people.3 This means that they do not happen in about 99 out of 100 people. Another serious problem affects the pulmonary
vein and happens in about 1 to 6 people out of 100 people.3, 6 This means that it does not happen in about 94 to 99 people out of 100.

Death from the procedure is very rare. It happens to about 1 out of 1,000 people.3 This means that 999 out of 1,000 people don't die from the procedure.

Problems after the procedure

Problems after the procedure can be minor (such as mild pain) or serious (such as bleeding). Your doctor will check you closely after the procedure. He or she can fix most of these problems.

The most common problems are related to the catheter that was inserted in a vein. Most of these vein problems aren't serious. They include minor pain, bleeding, and bruising. Vein problems happen in 0 to 13 people out of 1002. This means that they don't happen in 87 to 100 people out of 100. In a worldwide survey, serious vein problems happened in 1 out every 100 people.4

Serious problems aren't common. These problems include stroke and new heart rhythm problems. A rare problem is a life-threatening problem with the esophagus (atrio-esophageal
fistula) that happens to about 1 out of 1,000 people.3 This means it doesn't happen to 999 out of 1,000 people.

Weighing the risks and benefits of catheter ablation

The benefits may outweigh the risks if:

The risks may outweigh the benefits if:

You have
symptoms that bother you a lot.

You do not want to take heart rhythm medicines.

Heart rhythm medicines aren't
helping.

Medicines help, but their side effects bother you a
lot.

You can't take the medicines because of other health
problems.

You have only mild symptoms that don't
really bother you.

You aren't bothered by side effects of
heart rhythm medicines.

Compare your options

Compare

What is usually involved?

What are the benefits?

What are the risks and side effects?

Have catheter
ablationHave catheter
ablation

The treatment is done in a hospital and takes 2 to 6
hours.

You probably will not
be fully awake during the treatment. You may be
lightly sedated or completely asleep.

You may have some discomfort, either from having to lie still
or from the ablation itself. Talk to your doctor if you are worried about
this.

You will probably stay in the
hospital for 1 or 2 days.

Many people feel a lot better after this
treatment.

If the treatment works, you won't need heart rhythm medicine.

Ablation has serious risks, although they are rare. They include
stroke and death.

If ablation doesn't work the first
time, you may need to have it done again.

Don't have catheter
ablation Don't have catheter
ablation

You take heart rhythm medicine to treat
atrial fibrillation.

You don't have to worry about the rare but
serious risks of ablation.

You will likely continue to have symptoms of atrial fibrillation.

Heart rhythm medicines may
increase your risk of getting a more serious heart rate problem. You will need
frequent checkups so your doctor can watch you closely while you take these
medicines.

If you also have heart disease, your risk of serious
side effects from these medicines may be higher.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about considering catheter ablation

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

Medicines
have helped my symptoms a little, but not completely. My doctor talked to me
about catheter ablation, but I really don't want to have a procedure on my heart. I can live with my symptoms for now.

Candace, age 58

My doctor
has been treating my atrial fibrillation with medicines. But taking them is
worse than the palpitations. I'm tired all the time, and I have dizzy spells so
often that I can't work. I'm ready to try catheter ablation.

Sophie, age 54

I've already tried one medicine to treat my atrial fibrillation. I still had symptoms that bother me a lot, so my doctor prescribed a different medicine. I think I'll try this one before I think about having an ablation. If my new medicine still doesn't help, I can try ablation later.

George, age 60

My doctor said the risks of ablation are pretty rare. I just want to get this problem fixed so I feel better. I'm going to have the procedure.

Wei, age 49

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have catheter ablation

Reasons not to have
catheter ablation

I'm not worried about having a procedure that involves my heart.

I'm very worried about having a procedure that involves my heart.

More important

Equally important

More important

The side effects of my heart medicines are bothering me a lot.

The medicine side effects don't bother me that much.

More important

Equally important

More important

I'm bothered a lot by my heart rhythm symptoms.

My symptoms don't bother me.

More important

Equally important

More important

I'm not happy with my quality of life, either because of my symptoms or because of medicine side effects.

My quality of life is pretty good.

More important

Equally important

More important

The risks of ablation don't bother me as much as the risks of continuing to take my medicines.

I prefer the risks of taking my medicines over the risks of having catheter ablation.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having catheter ablation

Not having catheter ablation

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.

Does catheter ablation work well for everyone with atrial fibrillation?

YesSorry, that's not right. Catheter ablation helps many people who have atrial fibrillation. But it doesn't work for everyone. It works best for younger people who have paroxysmal atrial fibrillation and little or no structural heart disease.

NoYou're right. Catheter ablation helps many people who have atrial fibrillation. But it doesn't work for everyone. It works best for younger people who have paroxysmal atrial fibrillation and little or no structural heart disease.

I'm not sureIt may help to go back and read "Get the Facts." Catheter ablation helps many people who have atrial fibrillation. But it doesn't work for everyone. It works best for younger people who have paroxysmal atrial fibrillation and little or no structural heart disease.

2.

Are blood thinners that are used to lower the risk of stroke still needed after catheter ablation?

YesThat's correct. Experts don't know if ablation lowers the
risk of stroke. If a person takes a blood thinner before having an ablation, he or she will continue to take it to lower the risk of stroke.

NoSorry, that's not right. Experts don't know if ablation lowers the
risk of stroke. If a person takes a blood thinner before having an ablation, he or she will continue to take it to lower the risk of stroke.

I'm not sureIt may help to go back and read "Get the Facts." Experts don't know if ablation lowers the
risk of stroke. If a person takes a blood thinner before having an ablation, he or she will continue to take it to lower the risk of stroke.

3.

If ablation doesn't work the first time, can it be done again?

YesThat's right. You may need to have it done a second time. Repeated ablations have a higher chance of success.

NoSorry, that's not correct. If the first ablation doesn't get rid of the problem completely, you may need to have it done a second time. Repeated ablations have a higher chance of success.

I'm not sure.It may help to go back and read "Get the Facts." You may need to have it done a second time. Repeated ablations have a higher chance of success.

January CT, et al. (2014). 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, published online March 28, 2014. DOI: 10.1161/CIR.0000000000000041. Accessed April 18, 2014.

Agency for Healthcare Research and Quality (2009). Comparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation (AHRQ Publication No. 09-EDC015-EF). Rockville, MD: Agency for Healthcare Research and Quality. Also available online: http://www.effectivehealthcare.ahrq.gov/ehc/products/51/114/2009_0623RadiofrequencyFinal.pdf.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Atrial Fibrillation: Should I Have Catheter Ablation?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Have catheter ablation.

Don't have catheter ablation.

Key points to remember

Catheter ablation is a way to treat atrial fibrillation. It is done to restore a normal heart rhythm and to relieve symptoms.

Ablation can relieve symptoms and improve the quality of life in people with atrial fibrillation. But it doesn't work for everyone.

If atrial fibrillation happens again after the first ablation, you may need to have it done a second time. Repeated
ablations have a higher chance of success.

Catheter ablation is thought to be safe. It has some serious
risks, such as
stroke, but they are rare.

If you take a blood-thinning medicine to prevent stroke, you will continue to take it after an ablation.

FAQs

What is catheter ablation?

Normally, the heart
has a strong, steady beat. That beat is controlled by the heart's electrical
system. Sometimes that system misfires, causing atrial fibrillation.

Catheter ablation is a way to treat atrial fibrillation. Your doctor can get into your
heart—without surgery—and fix the misfiring. It's like working on the spark
plugs in your car without having to open the hood.

It's done in a hospital. You'll get medicines to make you sleepy and comfortable during the procedure.

The
doctor inserts thin, flexible wires called catheters into a vein, usually
in the groin or neck. Then the doctor threads the catheters up into your heart.

X-rays and other images of the heart help the doctor
see where to move the catheters.

The catheters use very hot or
very cold temperatures to destroy the areas in your heart that are causing the
misfiring problem.

It may seem like a bad idea to destroy parts of your
heart on purpose. But the areas that are destroyed are very tiny and
don't affect your heart's ability to do its job.

When is catheter ablation done?

You and your doctor can check a few things to see if ablation is a good choice for you. These things include:1, 2

If you have tried heart rhythm medicines already. Your symptoms may not have gone away or you had side effects that are hard to live with.

The choice to have catheter ablation also depends on what you want.

Catheter ablation does
have some serious risks, but they are rare.
Many people decide to have ablation because they
hope to feel much better afterward. That hope is worth the risks to them.
But the risks may not be worth it for people who have few symptoms or for people
who are less likely to be helped by ablation.

Taking anticoagulants (blood thinners)

Many
people think that having ablation means they'll be able to stop taking an anticoagulant (also called a blood thinner), such as warfarin, every day to prevent
stroke. But that is only true if your risk of stroke
is low. Studies haven't proved that ablation for atrial fibrillation lowers your
risk of stroke. So you'll still need to take an anticoagulant if your risk of stroke
remains high. Your doctor can tell you about your stroke risk.

How well does catheter ablation work?

Catheter ablation can stop atrial fibrillation from happening and can relieve symptoms. Your doctor can help you decide if ablation is a good choice based on your health.

Catheter ablation works better in people who have paroxysmal atrial fibrillation (episodes last 7 days or less) than in people who have persistent atrial fibrillation (episodes last more than 7 days). For both types, episodes may go away on their own or go away after treatment. Ablation might be less likely to work the longer a person has persistent atrial fibrillation.2

Ablation works best for younger people who have paroxysmal atrial fibrillation and little or no structural heart disease.

Things that limit how well catheter ablation works include older age, other heart problems, obesity, and sleep apnea.2

Catheter ablation is still
being studied to see how well it works and how safe it is in the long
term.

Paroxysmal atrial fibrillation

Research shows that ablation
helps more than 70 to 80 out of 100 people.3
That means it does not help in about 20 to 30 out
of 100 cases.

Persistent atrial fibrillation

Research shows that ablation helps about
50 out of 100 people.2, 5 That means it doesn't work in
about 50 out of 100 cases.

In a worldwide survey, ablation helped about 65 out of every 100 people.4

Repeated ablation procedures

If the
first procedure doesn't get rid of atrial fibrillation completely, you may need to have it done a second time. Repeated ablations have a
higher chance of success.

Research shows that a second ablation is needed in 20 to 40 people out of 100. This means that 60 to 80 out of 100 people don't need another ablation.2

What are the risks?

Catheter ablation is considered safe. Most people do well afterward.

Your doctor can help you decide whether the possible benefits of
ablation outweigh these risks.

Problems during the procedure

If problems happen during the procedure, your doctor is prepared to fix them right away. In studies and a worldwide survey, serious problems happened in about 4 out 100 people.6, 4 These problems include an accidental hole in the heart, the need for emergency surgery, and nerve damage in the chest.

Rare problems include cardiac tamponade and stroke. They happen in about 1 out of 100 people.3 This means that they do not happen in about 99 out of 100 people. Another serious problem affects the pulmonary
vein and happens in about 1 to 6 people out of 100 people.3, 6 This means that it does not happen in about 94 to 99 people out of 100.

Death from the procedure is very rare. It happens to about 1 out of 1,000 people.3 This means that 999 out of 1,000 people don't die from the procedure.

Problems after the procedure

Problems after the procedure can be minor (such as mild pain) or serious (such as bleeding). Your doctor will check you closely after the procedure. He or she can fix most of these problems.

The most common problems are related to the catheter that was inserted in a vein. Most of these vein problems aren't serious. They include minor pain, bleeding, and bruising. Vein problems happen in 0 to 13 people out of 1002. This means that they don't happen in 87 to 100 people out of 100. In a worldwide survey, serious vein problems happened in 1 out every 100 people.4

Serious problems aren't common. These problems include stroke and new heart rhythm problems. A rare problem is a life-threatening problem with the esophagus (atrio-esophageal
fistula) that happens to about 1 out of 1,000 people.3 This means it doesn't happen to 999 out of 1,000 people.

Weighing the risks and benefits of catheter ablation

The benefits may outweigh the risks if:

The risks may outweigh the benefits if:

You have
symptoms that bother you a lot.

You do not want to take heart rhythm medicines.

Heart rhythm medicines aren't
helping.

Medicines help, but their side effects bother you a
lot.

You can't take the medicines because of other health
problems.

You have only mild symptoms that don't
really bother you.

You aren't bothered by side effects of
heart rhythm medicines.

2. Compare your options

Have catheter
ablation

Don't have catheter
ablation

What is usually involved?

The treatment is done in a hospital and takes 2 to 6
hours.

You probably will not
be fully awake during the treatment. You may be
lightly sedated or completely asleep.

You may have some discomfort, either from having to lie still
or from the ablation itself. Talk to your doctor if you are worried about
this.

You will probably stay in the
hospital for 1 or 2 days.

You take heart rhythm medicine to treat
atrial fibrillation.

What are the benefits?

Many people feel a lot better after this
treatment.

If the treatment works, you won't need heart rhythm medicine.

You don't have to worry about the rare but
serious risks of ablation.

What are the risks and side effects?

Ablation has serious risks, although they are rare. They include
stroke and death.

If ablation doesn't work the first
time, you may need to have it done again.

You will likely continue to have symptoms of atrial fibrillation.

Heart rhythm medicines may
increase your risk of getting a more serious heart rate problem. You will need
frequent checkups so your doctor can watch you closely while you take these
medicines.

If you also have heart disease, your risk of serious
side effects from these medicines may be higher.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.

Personal stories about considering catheter ablation

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"Medicines have helped my symptoms a little, but not completely. My doctor talked to me about catheter ablation, but I really don't want to have a procedure on my heart. I can live with my symptoms for now."

— Candace, age 58

"My doctor has been treating my atrial fibrillation with medicines. But taking them is worse than the palpitations. I'm tired all the time, and I have dizzy spells so often that I can't work. I'm ready to try catheter ablation."

— Sophie, age 54

"I've already tried one medicine to treat my atrial fibrillation. I still had symptoms that bother me a lot, so my doctor prescribed a different medicine. I think I'll try this one before I think about having an ablation. If my new medicine still doesn't help, I can try ablation later."

— George, age 60

"My doctor said the risks of ablation are pretty rare. I just want to get this problem fixed so I feel better. I'm going to have the procedure."

— Wei, age 49

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have catheter ablation

Reasons not to have
catheter ablation

I'm not worried about having a procedure that involves my heart.

I'm very worried about having a procedure that involves my heart.

More important

Equally important

More important

The side effects of my heart medicines are bothering me a lot.

The medicine side effects don't bother me that much.

More important

Equally important

More important

I'm bothered a lot by my heart rhythm symptoms.

My symptoms don't bother me.

More important

Equally important

More important

I'm not happy with my quality of life, either because of my symptoms or because of medicine side effects.

My quality of life is pretty good.

More important

Equally important

More important

The risks of ablation don't bother me as much as the risks of continuing to take my medicines.

I prefer the risks of taking my medicines over the risks of having catheter ablation.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having catheter ablation

Not having catheter ablation

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Does catheter ablation work well for everyone with atrial fibrillation?

Yes

No

I'm not sure

You're right. Catheter ablation helps many people who have atrial fibrillation. But it doesn't work for everyone. It works best for younger people who have paroxysmal atrial fibrillation and little or no structural heart disease.

2.
Are blood thinners that are used to lower the risk of stroke still needed after catheter ablation?

Yes

No

I'm not sure

That's correct. Experts don't know if ablation lowers the
risk of stroke. If a person takes a blood thinner before having an ablation, he or she will continue to take it to lower the risk of stroke.

3.
If ablation doesn't work the first time, can it be done again?

Yes

No

I'm not sure.

That's right. You may need to have it done a second time. Repeated ablations have a higher chance of success.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

Yes

No

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2.
Check what you need to do before you make this decision.

I'm ready to take action.

I want to discuss the options with others.

I want to learn more about my options.

3.
Use the following space to list questions, concerns, and next steps.

Credits

By

Healthwise Staff

Primary Medical Reviewer

Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology

Specialist Medical Reviewer

John M. Miller, MD, FACC - Cardiology, Electrophysiology

References

Citations

January CT, et al. (2014). 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, published online March 28, 2014. DOI: 10.1161/CIR.0000000000000041. Accessed April 18, 2014.

Agency for Healthcare Research and Quality (2009). Comparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation (AHRQ Publication No. 09-EDC015-EF). Rockville, MD: Agency for Healthcare Research and Quality. Also available online: http://www.effectivehealthcare.ahrq.gov/ehc/products/51/114/2009_0623RadiofrequencyFinal.pdf.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

January CT, et al. (2014). 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, published online March 28, 2014. DOI: 10.1161/CIR.0000000000000041. Accessed April 18, 2014.

Agency for Healthcare Research and Quality (2009). Comparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation (AHRQ Publication No. 09-EDC015-EF). Rockville, MD: Agency for Healthcare Research and Quality. Also available online: http://www.effectivehealthcare.ahrq.gov/ehc/products/51/114/2009_0623RadiofrequencyFinal.pdf.

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How this information was developed to help you make better health decisions.